Vaccination strategies for children with specific medical conditions: a paediatrician's viewpoint.
Children with underlying medical conditions have to be given careful attention at the time of planned immunization in order to define the individual benefit/risk ratio of a given vaccination. Analysis of available data demonstrates that vaccine administration is indeed both safe and efficient in most children. Immunization of very premature infants may require specific vaccine strategies consisting either of short-term deferral of immunization or the addition of an extra vaccine dose. With the exception of influenza immunization of children with egg allergy, immunization is safe and efficient in atopic or asthmatic children. A family or personal history of seizure without evidence of encephalopathy is no longer considered a limitation to pertussis immunization. Children with mild intercurrent infection can be immunized without further delay. Repeated pneumococcal immunization should be offered to children at high risk of pneumococcal disease after the age of 2 years. Optimal protection of immunodeficient children could include immunization of family members.


CONCLUSIONS
This article attempts to review existing data upon which immunization practices have been recommended by expert societies. It outlines some areas that need additional studies before specific recommendations can be made and it proposes attitudes that could be considered in the meantime.
Siegrist
C A
CA
Centre for Vaccinology and Neonatal Immunology, University Children's Hospital of Geneva, Switzerland. siegrist@cmu.unige.ch
D000208:Acute Disease; D001249:Asthma; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005938:Glucocorticoids; D006304:Health Status; D006402:Hematologic Diseases; D006801:Humans; D006967:Hypersensitivity; D007153:Immunologic Deficiency Syndromes; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D009422:Nervous System Diseases; D014611:Vaccination / Q000592:standards; D014612:Vaccines / Q000008:administration & dosage*
D005938:Glucocorticoids; D014612:Vaccines